Daniel Scherzer, MD, aims to show people how to use epinephrine injectors, hoping more lives can be saved from deadly anaphylaxis.

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THURSDAY, August 9, 2012 — Daniel Scherzer, MD, works in the emergency department at Nationwide Children's Hospital in Columbus, Ohio, and he's seen parents walk in with children experiencing full-blown, life-threatening anaphylaxis — and unused EpiPens. He wants to change that.

Epinephrine injectors, like the widely prescribed EpiPen (other brands include Adrenaclick and Adrenalin), are devices that inject a dose of synthetic epinephrine, a hormone that counteracts life-threatening allergic reactions. Swift and correct usage can save lives from airway obstruction and plummeted blood pressure.

"In this country, there are about 100 to 150 people every year that die from a food allergy reaction," Scherzer says in a release from Nationwide Children's Hospital. "Approximately half of those people actually had epinephrine in the vicinity and was available to them. The medication just wasn't used or it wasn't used in time."

Don't Fear Epinephrine

Dr. Scherzer, who also teaches at Ohio State University College of Medicine, wants more people to know how and when to use epinephrine injectors, specifically education staff beyond school nurses.

"School nurses can't be everywhere all at once," he says, so it's important for other school staff (and anyone who cares for a child with food allergies) to learn.

With help from colleagues at Nationwide Children's, Scherzer created an assessment and teaching program based on recognition and response to food-induced anaphylaxis. It begins with a survey to assess if participants know what to do and when.

So far, he's noticed three common problems with people using epinephrine injectors:

Recognizing when to use it.

"On paper it looks easy," Scherzer says. "People know the standard description of symptoms to look for, like facial swelling, trouble swallowing, hives, and dizziness. But in reality it's a lot sloppier than on paper. The borders aren't as crisp."

A child might seem fine, but complain of a sore throat at first. It might take several minutes, or hours, for the reaction to build. But once it does, you go over the cliff fast, as Scherzer puts it. If you can see that someone's face is swelling, they have hives and a red body rash, or have trouble breathing or swallowing, he recommends giving the injection.

How to use it.

It seems simple enough: You take the pen out of its case, take off the safety cap, and press it into the thigh. The needle is spring-loaded, meaning it is released by pressing the flat end of the "pen" — which is more like the size of a large marker — into the meatiest part of the thigh near the butt. The needle shoots out into the skin and the epinephrine is released into the muscle. But under stress, this might seem difficult and not come easily. Practice with the tester pen that comes with the prescription pen until it becomes second nature.

Natural hesitancy.

The idea of injecting someone can be intimidating if, like most of us, you're not used to it. "An epinephrine injection seems particularly aggressive," Scherzer says. "It's an injection, it's all or none, and you may have to give it someone who isn't obviously that sick." This might hold back a person back from giving someone the injection, potentially endangering them. If epinephrine were shot into someone having no reaction, the dose of epinephrine is unlikely to cause significant side effects in an otherwise healthy person, Scherzer says.

Scherzer knows this hesitancy firsthand. When his daughter, almost 7, recently had an allergic reaction brought on by food, he and his wife (an allergist) hemmed and hawed before giving her the injection.

Teaching People How to Use Epinephrine

The second part of Scherzer's workshop, which he's already given to more than 100 school nurses, education aids, and camp counselors in Central Ohio, involves teaching them what to do.

"Everyone enjoys going through the process, and everyone learns something from it," he says.

Scherzer is working with a biostatistician at Nationwide Children's Hospital to evaluate and publish their workshop findings. "When that's written," he says, "I can share it with researchers at other institutions to develop a multi-regional approach."

Research has shown that hesitation to get involved is a common reaction across all emergency situations, such as performing CPR or using an AED (automated external defibrillator) on a person in cardiac arrest. The more people, especially those who work with children, who are trained on how and when to use epinephrine injectors, the way they are shown how to use AEDs or perform CPR, the more lives might be saved.

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